Changing the course of comorbid eating disorders and depression: what is the role of public health interventions in targeting shared risk factors?

Abstract

Public health has a productive history of improving global health due to its focus on reaching large populations using effective and scalable interventions. Yet, the marriage between evidence-based science and the implementation of community/public health interventions within mental illness remains underdeveloped. Research suggests that major depression is the most commonly cited comorbidity for eating disorders (EDs). Thus, identification of public health strategies that jointly impact depression and EDs, including shared risk factors, has the potential to significantly impact mental health suffering. The primary aim of this paper is to examine and discuss such public health approaches as well as explore cues taken from public health efforts to inform future directions in research and clinical practice. As a comprehensive review of all public health initiatives that address EDs and depression is beyond the scope of this paper, this paper reviews a series of programs/approaches that either are of large scale and/or have received empirical support. In particular, public health related interventions that aim to reduce variable risk factors associated with EDs and depression, as well as interventions that aim to reduce continuous measures of ED and depression symptoms are reviewed. To date, despite significant progress in modifying risk factors for EDs and depression, the field still lacks a public health study that has been appropriately designed and/or adequately powered to assess true ED/depression prevention effects. Further, although several programs show promise, many widely disseminated approaches lack empirical support, raising concerns about the potential for waste of limited resources. In summary, although the combination of prevention and public health based approaches appear to have merit when trying to move the needle on risk factors and symptoms associated with EDs and/or depression, further research is needed to investigate the reach and effectiveness of large scale dissemination efforts of such endeavors.

The psychenet public health intervention for anorexia nervosa: a pre–post-evaluation study in a female patient sample

“…the other after implementation. Future studies evaluating the effect of public health interventions on early treatment among patients with AN should apply a randomized controlled design with a sufficiently large sample to increase internal validity (Becker et al, 2014).…”

Shared risk factors for mood-, eating-, and weight-related health outcomes.

“…We further hypothesized that body dissatisfaction, dieting behaviors, and weight-related teasing during early/middle adolescence and middle adolescence/early young adulthood would be shared risk factors for depressive symptoms, disordered eating, and excess weight status at 5-year and 10-year follow-up. We focused on behavioral, psychological, and interpersonal risk factors (e.g., as opposed to familial or biological risk factors) because these are among the most compelling modifiable risk factors to date as reviewed in the literature (Becker et al, 2014). As such, they have the potential to serve as key targets for future public health interventions aimed at reducing risk for all three outcomes.…”

Epidemiology of eating disorders part III: social epidemiology and case definitions revisited

“…In the literature, over 60 programmes have been identified, most of them with no or just short-lived effects (Ciao, Loth & Neumark-Sztainer, 2014). Hence, the issue has pertinently been raised (Becker et al, 2014) about the feasibility of spending societal money as well as time and energy on disseminating ineffective programmes. On the other hand, though, adolescence is a high risk for the onset of many common mental disorders.…”